Oral surgeon's technique of mandibular block

[simpledoc]

i know that we have discussed about giving mandibular blocks before...but just thought getting inputs from all the oral surgery people out here, IF they have any CONSISTENTLY SUCCESSFUL mandibular block technique? I know you guys have the advantage that if your blocks fail, you can immediately convince the patient to get sedated and take out the teeth....but am also sure that you guys may have some small tricks for success, which you could share with us and will probably benefit many of us... thanks in advance..

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[OMFSCardsFan]

i know that we have discussed about giving mandibular blocks before...but just thought getting inputs from all the oral surgery people out here, IF they have any CONSISTENTLY SUCCESSFUL mandibular block technique? I know you guys have the advantage that if your blocks fail, you can immediately convince the patient to get sedated and take out the teeth....but am also sure that you guys may have some small tricks for success, which you could share with us and will probably benefit many of us... thanks in advance..

I typically aim higher than the standard IAN technique--basically splitting the difference between the IAN and Gow-Gates blocks. I'll also usually drop half a carpule, then redirect to a nearby location for the other half. I feel as though it covers a larger area. I always wait for lip numbness before giving the long buccal, since this can simulate a numb feeling. Normally, I give the IAN, write a note, get some lip numbness, give the LB, then start.

There are a lot of people out there that will never be able to distinguish pressure from pain. Sometimes for the dramatic ones, to help clarify the difference when I believe them to be numb, I'll poke the opposite side with my periosteal. They will usually jump and throw out an "ouch," at which point they understand the difference. Call me a jerk, but when you've got 20 patients to see in a morning, you can't be messing around trying to explain the difference...

 

[toofache32]

There are a lot of people out there that will never be able to distinguish pressure from pain. Sometimes for the dramatic ones, to help clarify the difference when I believe them to be numb, I'll poke the opposite side with my periosteal. They will usually jump and throw out an "ouch," at which point they understand the difference. Call me a jerk, but when you've got 20 patients to see in a morning, you can't be messing around trying to explain the difference...

I do the same thing. Also, never ask "does this side of your lip feel numb?" They often don't know what "numb" should feel like. Always ask "does this side feel the same or different from the other side?" Because that's all you really want to know anyway.

 

[DcS]

I typically aim higher than the standard IAN technique--basically splitting the difference between the IAN and Gow-Gates blocks. I'll also usually drop half a carpule, then redirect to a nearby location for the other half. I feel as though it covers a larger area. I always wait for lip numbness before giving the long buccal, since this can simulate a numb feeling. Normally, I give the IAN, write a note, get some lip numbness, give the LB, then start.

I use a pretty similar technique. I also like to bend the needle about 30 degrees because it makes it easier for me to come in at the angle I want. I know Malamed quotes something like IABs having a 20 or 30% failure rate but in my 4 years of school and externships I can count on one hand the number of times I've missed. I do some things I was told not to do by instructors, like the bending of the needle I mentioned and repositioning once buried to spread the location of the anesthetic.

One of the few I missed had extremely high openings to the canals so a Gow-Gates takes care of her.

 

[OMFSCardsFan]

I also like to bend the needle about 30 degrees because it makes it easier for me to come in at the angle I want.

Good call...I forgot to mention that...

 

[DrJeff]

I'm not an OMFS, just a *lowly GP* that's been "stabbing" people for 10 years now. The afforementioned info is basically what I do, right on down to the bending the needle. When I ask a patient if they're numb, I've learned if they have to think about it for a moment or too, then they're not numb, with a properly administered IAB it's a "night and day" difference between the sides.

Another tip that I use, is that upon injection, I look to hit the medial surface of the ascending ramus and then "walk" the needle back until I feel it "fall" off the posterior border of the ramus. I'll then bring the needle tip just anteriorly back onto the ramus and administer the anesthetic. By using this technique, I'll get all but maybe 2 or 3 IAB's I administer a year.

 

[toofache32]

Another tip that I use, is that upon injection, I look to hit the medial surface of the ascending ramus and then "walk" the needle back until I feel it "fall" off the posterior border of the ramus. I'll then bring the needle tip just anteriorly back onto the ramus and administer the anesthetic.

Damn how long are your needles?

 

[DrJeff]

I use the shorties, I just push really hard!

Seriously, I use a 30 guage short 99% of the time. We do have some 27 guage longs in my office, and I haven't seen one of those red capped 25 guage long "harpoons" since dental school.

In all the but biggest of patients I'll be able to find bone with the tip of the 30 short.

 

[toofache32]

I use the shorties, I just push really hard!

Seriously, I use a 30 guage short 99% of the time. We do have some 27 guage longs in my office, and I haven't seen one of those red capped 25 guage long "harpoons" since dental school.

In all the but biggest of patients I'll be able to find bone with the tip of the 30 short.

That's interesting. I was impressed by how you walk all the way off the posterior edge of the ramus, that's pretty deep.

Also, if you bend your needles, DON"T bend them back straight. Just leave it or get a new one if you need a straight needle. Bending it again is setting you up for a broken needle lost in your patient's infratemporal space or some other bad location. Hell they're all bad.

 

[DrJeff]

That's interesting. I was impressed by how you walk all the way off the posterior edge of the ramus, that's pretty deep.

Also, if you bend your needles, DON"T bend them back straight. Just leave it or get a new one if you need a straight needle. Bending it again is setting you up for a broken needle lost in your patient's infratemporal space or some other bad location. Hell they're all bad.

It seems more impressive in writing than in practice. My technique has my injection location already more posterior than the classical location. The "walking back onto the ramus" part was a descriptive tip/technique that I learned during the 2nd year of my GPR when one of the 1st year residents( a Case Western grad) and I were talking techniques with a dental student who was on an externship, and was having problems hittint blocks.

This 1st year resident went onto become a very good chief resident and now is doing great in private practice with her patient's loving her (she refers many patients to my wife for ortho tx and all of them rave about how good she explains things to them).

 

[aphistis]

It seems more impressive in writing than in practice. My technique has my injection location already more posterior than the classical location. The "walking back onto the ramus" part was a descriptive tip/technique that I learned during the 2nd year of my GPR when one of the 1st year residents( a Case Western grad) and I were talking techniques with a dental student who was on an externship, and was having problems hittint blocks.

This 1st year resident went onto become a very good chief resident and now is doing great in private practice with her patient's loving her (she refers many patients to my wife for ortho tx and all of them rave about how good she explains things to them).

Catch the game tonight, DrJeff? 13 more seconds...bloody shame they didn't hang on, but after they called the first timeout on the last Colts series, I was rooting for Dungy to go for the throat and put it in the end zone again. November 7 is getting closer by the day.

 

[DrJeff]

November 7 is getting closer by the day.

Calender is marked, already making plans to have my wife watching the kid for the entire game time! Have my daughter's Tom Brady jersey ready. That will culminate a great start by the Pats having beaten The Raiders, Carolina, Pittsburgh, and Atlanta by then!

Watch out Bill, I honestly think that Brady actually has a bigger and deeper core of guys to throw the ball to than Peyton does this year.

 

[aphistis]

Calender is marked, already making plans to have my wife watching the kid for the entire game time! Have my daughter's Tom Brady jersey ready. That will culminate a great start by the Pats having beaten The Raiders, Carolina, Pittsburgh, and Atlanta by then!

Watch out Bill, I honestly think that Brady actually has a bigger and deeper core of guys to throw the ball to than Peyton does this year.

That's a pretty tall claim! I didn't get to see the opener Thursday, but I'll be sure to keep an eye on the Pats' passing game the next couple weeks. I'm skeptical to say the least.

 

[simpledoc]

ok this is not against anyone in specific..(not even against the moderator)..but why do some of the SDN threads (just when it becomes so informative and exciting) always takes a right angled deviation to some senseless topic? can some one continue with the mandibular block technique again??

 

[aphistis]

ok this is not against anyone in specific..(not even against the moderator)..but why do some of the SDN threads (just when it becomes so informative and exciting) always takes a right angled deviation to some senseless topic? can some one continue with the mandibular block technique again??

Fair enough. That was my bad, but DrJeff and I have been heckling each other about football for two or three seasons now. Sorry for diverting.

 

[toofache32]

ok this is not against anyone in specific..(not even against the moderator)..but why do some of the SDN threads (just when it becomes so informative and exciting) always takes a right angled deviation to some senseless topic? can some one continue with the mandibular block technique again??

Can someone tell me where babies come from?

 

[kato999]

Fair enough. That was my bad, but DrJeff and I have been heckling each other about football for two or three seasons now. Sorry for diverting.

This doesn't have to do with the the IA exactly, but I had a patient who is an ex-addict and was very difficult to get numb for a 2 quads of SRP. He had been addicted to meth, heroin, lsd amonst others for 25 years. I used one carpule of 2% lido with epi for the IA and a 1/2 carp for the long buccal. the pt wasn't getting numb so I tried I rubbing topical all over the gums before putting more lido into him and then he was fine. The same was true for the maxillary. Anyone seen or heard of this before?

Also, I am looking forward to Tom Brady's next interview, as he will be wearing a Notre Dame cap

 

[simpledoc]

Can someone tell me where babies come from?

ask yur mama
oops sorry for goin off topic!

 

[Jediwendell]

It's not so much where you put the needle, it's how fast you put the anesthetic in. If you can't empty the carpule in less than a second you can't do an OMS IAN block.

 

[toofache32]

It's not so much where you put the needle, it's how fast you put the anesthetic in.

Translation: "It's not the size of the worm, it's how you wiggle it."

If you can't empty the carpule in less than a second you can't do an OMS IAN block.

Preach it brother! You'll always be one of us you ol' wire-bender!

 

[Jediwendell]

Yeah. Here in a few minutes I will tell you how to do an orthodontic IAN block. Don't go away now, it will just be a little while til I can get to it. I'm just too darned busy right now.........

Translation: "It's not the size of the worm, it's how you wiggle it."


Preach it brother! You'll always be one of us you ol' wire-bender!

 

[toofache32]

Yeah. Here in a few minutes I will tell you how to do an orthodontic IAN block. Don't go away now, it will just be a little while til I can get to it. I'm just too darned busy right now.........

They say orthodontists only need one finger...to point and say "bond that patient," "tighten those clasps". Oh yeah...and the one finger to count all your money.

 

[DrJeff]

They say orthodontists only need one finger...to point and say "bond that patient," "tighten those clasps". Oh yeah...and the one finger to count all your money.

What do you call a dentist that can't hit a block or use a hand piece????

An orthodontist!

 

[DrJeff]

Also, I am looking forward to Tom Brady's next interview, as he will be wearing a Notre Dame cap

Brady's a normal Monday AM interview on Boston sports radio (WEEI) and he was taking alot of grief from the co-hosts about having the wear the ND hat in a press conference this week I'm kind of torn, because on one hand due to my former GPR assistant program director who went of U of M dental school, gre up just outside of Ann Arbor and whose ada was on the faculty of U of M, I've spent many fall Saturday Afternoon at his house watching Michigan while have a few "cold and frosty beverages" Plus as a loyal patriots fan, I realize how important Michigan has been to the pats so I kind of feel bad for U of M. On the other hand I really hope for the best for Weiss and ND, so either way I could find something good out of that game.

BTW, what a stinker weekend for the Big 10 with Ohio State, Michigan and Iowa all taking a loss and a big hit in the rankings On a flip note, my 2004 Motor City Bowl champion UCONN Huskies have outscored their opponents 97-0 so far this year (38-0 against Buffalo and 59-0 against Liberty) - okay I know its against some weak teams, but 97-0 is still pretty impressive. Next up for my Huskies is at georgia tech this Sat, we'll see what happens. And 1 final note, boy is my wife great, afterall by the end of this Sunday, she will have allowed me to goto 2 college football games, 1 NFL game and a NASCAR NEXTEL Cup race all in a 17 day stretch(and consume all the beer associated with going to these events , withou giving me any serious grief She's really earning all the spa time she's aiming for when we go on vacation in a week!

 

[Football]

R

 

[OhioDMD]

Another experienced GP chiming in. What has been working like a charm is on traditional IAN followed by an Akinosi. Within 5 minutes my patients have profound anesthesia. Even works on pts that I have had less than stellar success with a traditional IAN.